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Friday, May 24, 2024

Urgent Care Centers

The patient was drinking more water than normal and thought it might be caused by COVID. Wanting a test, she went to the Cedar Hill Urgent Care Center (2228 Martin Luther King Jr. Ave. SE), where Dr. Harvey Lee did an examination. In addition to seeing patients himself, Lee is the Co-Medical Director of Cedar Hill Urgent Care GW Health.

It quickly became clear that it wasn’t COVID. Dr. Lee took a medical history and ran tests that confirmed his hypothesis. The patient was diabetic and possibly had been for years. Her last appointment had been long before this urgent care opened in the neighborhood.

Untreated, diabetes can lead to kidney damage, heart disease, blindness and a shorter life expectancy. So, Dr. Lee started the patient, who is not being named to protect her privacy, on medication. The clinic set the patient up with Medicaid. Lee also made a connection with primary care and specialists, following up a week later to check how things were going.

“So that it is one example where we definitely had an impact,” said Dr. Lee, “and hopefully effected a change in that person’s life.”

Something New in the Medical Landscape
Cedar Hill Urgent Care Center opened in October 2022. It’s the second urgent care clinic east of the river. In addition to Cedar Hill, MBI Urgent Care officially opened in March 2022 at 5140 Nannie Helen Burroughs Ave. NE. A new Ward 7 urgent care center is set to open in 2024 as part of the new Cedar Hill Regional Medical Center project.

Urgent care centers are something of a national trend. There are 14,418 urgent care centers in the USA and 17 in the District. Nationally, patient volume has increased by 60 percent since 2019, fueled by shortages in primary care. According to the American Association of Medical Colleges (AAMC) the United States will face a deficit of up to 124,000 physicians by 2034.

Gaps in health care have long been noted in District communities east of the river. Until the Cedar Hill Regional Hospital is complete in 2025, residents have limited access to services through the soon-to-close United Medical Center (UMC). Most primary and some secondary services in the area are offered through Federally Qualified Health Centers (FQHCs), notably Unity Health, which operates six Health Centers in the two wards.

Unity Health Care Chief Medical Officer Dr. Stephanie Cox-Batson. Courtesy Unity Health Care

A 2018 Primary Care Needs Assessment found that challenges to scheduling and access to care were two leading barriers to care for patients, positing walk-in urgent care as one solution. But other experts have argued that these facilities, designed to quickly diagnose and treat isolated issues, can divert patients from a long-term relationship with a primary care provider. That relationship, they argue, is key to preventative services that improve health outcomes and increase longevity.

What do these new urgent care clinics mean for health care east of the river?

Urgent Care
An urgent care center is a walk-in clinic outside of a hospital that diagnoses and treats minor illnesses and injuries in a relatively short visit. They often have an emergency physician on staff and can order lab tests and x-rays. In that way, they can serve as a middle ground between hospital emergency rooms and primary care providers, relieving stress on both systems.

Stress on emergency services is a concern in the District. A 2016 assessment by DC Fire Emergency Medical Services (DC FEMS) found that of the 170,000 calls placed to 911, non-emergency calls accounted for about 72 percent of calls. According to the study, “[t]hese types of transports overburden the EMS response network and reduce the availability of resources to respond to true emergencies,” not only tying up ambulance crews but also medical teams in local hospital Emergency Departments (EDs).

About 21 percent of ER visits from Wards 7 and 8 could be addressed in clinical settings, the 2018 DC Primary Care Needs Assessment found.

One reason Ward 7 and 8 residents turn to emergency services is because, compared to other parts of the city, it is difficult to access either hospitals or primary care.

When a patient calls 911, the DC FEMS team must take a patient to an ED, not leaving until the patient is in the care of a nursing team. The ability to get to an urgent care clinic can free up resources for life-threatening emergencies.

But urgent care doesn’t just reduce stress on the system. It is also cheaper. “You read stories about surprise bills all the time,” said Dr. Vivian Ho, the James A. Baker III Institute Chair in Health Economics at Rice University. “Someone comes in for stitches which could have been done at an urgent care center, and they get a $30,000 bill.”

A 2019 study found that average fees for treatment at EDs cost $1,700 compared to $180 at an urgent care. Ho says that’s largely because the clinics do not charge a facilities fee. That’s usually justified as covering the costs of specialists and equipment always available whether ED is dealing with a heart attack, a gunshot victim or an earache.

Detour or Doorway?
Critics of urgent care say that the convenience of dealing with a health issue quickly and without an appointment can divert patients from a relationship with a primary care provider.

Unity Health Services operates six health centers in Wards 7 and 8, providing a key portion of the primary care available east of the river. “Urgent care is an important part of the health care ecosystem,” Chief Medical Officer (CMO) Dr. Stephanie Cox-Batson said. “We are not taking away from that.” For instance, she said, urgent clinics can provide speedy access to x-rays, casting for fractures or suturing for extensive lacerations.

The problem, say critics, comes when urgent care is used as an alternative to, rather than in conjunction with, a primary care provider. Individuals with a regular primary care provider are more likely to receive health education and preventative services necessary to preventing and managing illness and death.

That’s because while urgent care focuses on a medical issue, primary care centers on the patient’s overall health. They will know if a medication made the patient nauseous or, if weight loss is a goal, to avoid prescriptions where weight-gain is a potential side effect.

“To have someone that understands your entire health history and your personal health goals—all of that is going to ultimately give you the very best health care,” said Dr. Cox-Batson. Often, those who turn to urgent care are those who fall through the cracks in primary care.

But Cedar Urgent Care’s Dr. Lee said sometimes those are not cracks, but doorways. He points to stories like that of the diabetic patient above. Rather than diverting patients from a primary care relationship, he said, the Cedar Hill urgent care facility tries to connect patients to care. They have conversations with Unity Health daily and monthly, for instance, referring patients to providers in the GW network and in the neighborhood.

“We feel obligated as an urgent care facility to help connect them with the other resources in the area,” said Lee, “and we’re willing to partner with anybody else that will set up shop there, to entice additional partners to come and join our efforts to provide additional resources and care to those citizens.”

DC: An Unusual Case
But the urgent care clinics coming as part of the Cedar Hill Medical Center are an exception to the national rule. Experts agree that it is unusual for urgent care clinics to open in economically disadvantaged areas. “Mostly, they go up in middle class suburbs, in shopping strips, where there are a lot of people with insurance and they can make a lot of money,” said Dr. Ho.

Instead, these new urgent care clinics provide walk-in care to communities that leaders have identified as medically underserved. Dr. Friedman expressed surprise when Dr. Lee’s anecdote about the diabetic patient was described to him. Most urgent care, he said, is not set up to refer patients to primary care or to insurance. That means urgent care is rarely a door to the medical ecosystem.

Studies have shown that when an urgent care center comes to an area, Medicare spending will increase over six years, presumably because providers diagnose conditions that require ongoing care. And some private investors can make urgent care a pipeline to additional business as they send patients to their providers or hospitals for additional care.

However, most data comes from urgent care located in affluent, privately-insured communities. “The effect of an urgent care in an area that was previously medically underserved could be very different,” Dr. Friedman said.

Unity’s Cox-Batson says she is glad patients have another option for urgent care. But, she notes, urgent care is not emergency care. “There is still a need for another level of care to complete this ecosystem east of the river,” she said.

Like many in the medical community, she says Unity is looking forward to the opening of the new Cedar Hill Hospital, saying it will go a long way toward completing the overall picture of healthcare east of the river.

“There are many pieces to the complete health picture,” she said. “Sometimes putting that picture together isn’t necessarily easy.” But completion is the goal, said the Unity CMO, and many people are committed to putting it together—with all of the different levels of care that are needed.

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